Gender-Inclusive Family Interventions in Domestic Violence : An Overview

Selection from prepublication, unedited version of chapter from J. Hamel & T. Nicholls (Eds.) Family Approaches to Domestic Violence: A Guide to Gender-Inclusive Research and Treatment, published by Springer Publishing, 2006.

John Hamel,  Ph.D., LCSW, Private Practice, Greater San Francisco Bay Area, CA
JohnMHamel@comcast.net • www.JohnHamel.net • (415) 472-3275

The accumulated body of data from family violence research conducted over the past three decades, including batterer treatment outcome studies, the literature on prevalence and context in intimate partner abuse and its effects on children, as well as research on child abuse and neglect, is summarized in table 2. For a more thorough overview, the interested reader is referred to the introduction to this volume, the recent book by Hamel (2005), or the groundbreaking paper by Dutton and Nicholls (2005). The systemic, gender-inclusive approach to domestic violence is based upon this research. It is empirically-driven, rather than ideologically-driven, drawing heavily upon previous models but represents a significant departure in other respects.

Family Violence Assessments: Who Comes In?

There are numerous reasons why partner and child abuse are under-detected (Aldorondo & Straus, 1994). Client-based reasons include the belief that violence is excusable, the desire to make a good impression, fear of further victimization and dependency needs. Among the therapist-based reasons are using inappropriate terminology (e.g., using vague terms such as “battering” rather than asking specific questions about discrete acts of violence), and failure to ask, or even see, both partners. When therapists do ask about violence, it is usually about violence directed against the mother or the children; adult male victims are an afterthought, at best. Seeing multiple family members increases the odds that abuse by either parent, or other family members, will be discovered. Children, particularly teens, are less concerned about making a good impression and may be more honest. An operating principle is for the clinician to interview as many family members, and in whatever combination, that will yield the maximum information about the family system without compromising anyone’s safety or unnecessarily alienating key family members.

Who is seen during the assessment process depends on a number of factors: 1) nature of the presenting problem, 2) legal constraints, and 3) client resistance. The clinician must ascertain who should be seen, and who can be seen. Unless the clinician is working specifically with a violent population (e.g., he/she is a Batterer Intervention Provider), the presenting problem may not be partner or child abuse. Adults seek help for depression, but are not immediately forthcoming about their victimization at the hands of their partner, which may have caused the depression. Parents who bring their son in for hitting his younger brother may have previously been abusive, to the children or each other. The adolescent girl brought in for drug use and curfew violations may be trying to escape a dysfunctional family system, in which emotional and physical abuse is perpetrated and reciprocated among all the family members.

The clinician must therefore be on the lookout for any signs of abuse. Among the risk factors for intimate partner abuse are: high conflict and relationship dissatisfaction; whether one partner is afraid of the other; aggressive personality or evidence of certain psychopathology such as Bipolar Disorder, ADHD, and personality disorder, particularly the “cluster B” group in the DSM-IV; violence in family or origin or violence in previous adult relationships; low SES, any alcohol or drug abuse – and corporal punishment. Risk factors for child abuse are similar (Merrill, Crouch, Thomsen & Guimond, 2004), and checklists are available (Milner and Chilamkurti, 1991.) Whenever, in fact, evidence is found for any type of abuse, the clinician should investigate the possibility that other types of abuse also exist. A more thorough discussion of risk factors, for both perpetrators and victims, including how to conduct a lethality assessment, can be found in the chapter by Nicholls et al., in this volume.

When clients are court-referred after a conviction for spousal abuse, there may be legal prohibitions against seeing perpetrator and victim together in the same session. The clinician may attempt to see the victim separately, if he/she is willing to oblige, or conduct an interview on the telephone. Collateral sources may be helpful. These would include contact with other mental health professionals previously or currently involved with the client and/or victim, and a review of documents from agency sources such as Probation or Child Protective Services. In cases involving voluntary clients, the clinician may have legal access to key family members who are nonetheless resistant to treatment. Strategies for engaging clients in treatment and building a therapeutic alliance can be found in Hamel (2005). One option is to conduct interviews separately with whomever is willing to participate, and to collect the information piecemeal. This author has had success in securing the participation of key but resistant family members by soliciting their “expertise” as crucial to the success of therapy.

Exploring the Family System

During the assessment process, the clinician will need to explore the important areas of family functioning that can directly or indirectly lead to conflict, abuse and violence. They are:

1. EACH INDIVIDUAL’S ABILITY TO COPE WITH ANGER, STRESS AND CONFLICT

Who has poor impulse control and tends to react to the slightest provocation by yelling, throwing things, or worse? In periods of high stress, are there certain family members around whom everyone must “walk on eggshells” lest they suddenly act out? Is there one “primary aggressor” whose internally-driven aggressive impulses generate the bulk of family conflict and dysfunction?

2. FAMILY BELIEFS ABOUT ANGER AND VIOLENCE

Is corporal punishment the preferred means of discipline? Are outbursts of verbal or physical abuse overtly disapproved, but tacitly allowed when someone has been “pushed over the limit.” Are certain transgressions, such as flirting, “fair game” for violence? Is violence by the father minimized because of society’s glorification of male violence, or mother’s violence ignored because it is less physically damaging?

3. FAMILY STRUCTURE

Differentiation and organization – Are each family member’s roles clearly defined, and appropriate for their abilities and developmental level? In unhealthy families, roles are unfulfilled (e.g., the mother who neglects her children due to chronic substance abuse), and definitions are blurred or reversed – e.g., the child who takes care of a battered mother, the chronically unemployed father who likes to “hang out” with his son to play video games.

Boundaries and Hierarchies – Emerging research (e.g., Davies & Sturge-Apple, this volume) finds associations between family conflict and boundary problems. The clinician needs to ask: Is there a clear boundary between the parental system and the child sub-system so that parental authority is maintained, yet permeable enough to allow for necessary information and communication from the children? Is there overinvolvement (enmeshment) or underinvolvement (disengagement) between individuals in the two subsystems? Is there an inappropriate alliance between a parent and child, causing the triangulation of another? In healthy families, the parental subsystem is not only separate from, but also above the child subsystem in the vertical hierarchical organization of its members.

Accessibility to Outside Influence – Are the boundaries with the outside world also appropriately permeable, allowing for the privacy and integrity of the family while allowing input necessary for growth and change? Or does a family code of secrecy prevent victims from accessing help against abuse?

Adaptability – How capable is the family system of adapting to stress and changes in circumstances? Can it maintain an optimum equilibrium of functioning, allowing for stability but flexible enough to grow and to increase its available set of responses?

4. RELATIONSHIP DYNAMICS

These include attachment styles (secure, anxious, avoidant, disorganized), communication and emotion expression, and how conflicts are handled. Is a particular relationship characterized by a control-compliance or control-control dynamic? When one person attacks, does the other counter-attack, defend, or else withdraw altogether? To what extend does fear of abuse (physical or emotional) shape any individual’s behavior?

5. THE FUNCTION OF EACH PERSON’S BEHAVIOR IN THE FAMILY CONTEXT

What are the likely repercussions within the family system for a given behavior? Consciously or unconsciously, human beings tend to do things for which there is some “payoff.” An adolescent, for instance, may become violent towards his/her parents as a way to prevent them from divorcing. A victim may consciously initiate a fight in order to “get it over with” before an important event (e.g., Christmas).

A number of questionnaires are available to the clinician conducting an assessment. To secure information about intimate partner abuse, recommended instruments are: the Conflict Tactics Scale (verbal and physical abuse prevalence rates), CTS-2 (verbal, physical, sexual and psychological abuse, and extent of injury), Controlling and Abusive Tactics Questionnaire (abuse and control), and the Anger Styles Questionnaire developed by Potter-Efron 2005). The standard instrument for measuring child abuse is the CTS-PC. A complete, step-by-step family violence assessment protocol can be found in Hamel (2005), including questions to ask children and reproductions of the above instruments (or information on how to order them.) Children and adolescents may be quite forthcoming about their parent’s violence, but not their own. At the Matters Program in New Zealand (Sheehan, 1997), the staff employ several sets of questions to obtain information while engaging the cooperation of adolescent perpetrator clients. A partial list, some of them applicable when working with other types of family violence, can be found in table 3.

Primary Aggressor Assessment, Responsibility and Empowerment

In justifying a couples approach to domestic violence, Goldner (1998) cited the “obsessive power of the relationship,” and the “confusing melodrama of the couple’s involvement” (p. 265), but also made it clear that a man’s violence is not caused by his relationship problems. In the gender-inclusive perspective, violence by the man or the woman, or by any of the children, may in fact be at least partially caused by stress and relationship issues; and physical aggression may be a response to verbal or emotional abuse, or to controlling behavior. However, it is equally true that violence is itself a cause of stress and relationship problems – in the same manner that personal problems (e.g., anxiety, depression, unsatisfactory peer relations) may lead to excessive drinking, and excessive drinking in turn brings it own share of dysfunction (e.g., more depression, job problems).

One must attend to both the abuse and the factors that contribute to, and are caused by, the abuse. However, it is important to point out that although family abuse is often reciprocal and mutual, and systemic factors serve to perpetuate abusive systems, violence is also caused and maintained by factors inherent in the individual, among them distorted and anti-social attitudes, a need to dominate, and poor impulse control (Dutton, 1998). Perpetration of abuse is should thus be considered a separate problem (Geller, 1998). In deciding who should be treated specifically for the abuse (e.g., through referral to an anger management or batterer program), one may begin with the work of Appel and Holden (1998), who propose five possible models of co-occurring spousal and child abuse. Their scheme, with some modification to bring it line with gender-inclusive research, is as follows:

• Single perpetrator – One parent abuses the other parent and the children.
• Sequential perpetrator – One parent abuses the other parent, who in turn abuses the children.
• Dual perpetrator – One parent abuses the other parent, and both parents abuse the children.
• Marital violence – The parents mutually abuse one another, and the children.
• Family dysfunction – Both parents abuse one another and the children, and the children abuse one or both of the parents and/or each other.

Although the last model is the most inclusive, it is often one of the other models that best explains the abuse in a particular family. To account for all possible combinations of family violence, this scheme may be expanded to include, for example, child abuse without partner abuse and partner abuse without child abuse, as well as child-perpetrated violence when there is no child abuse. Appel and Holden (1998) also point out that families are fluid, not static entities, and may pass through several models.

In identifying the pathways for abuse, one important consideration is determining the primary aggressor. This is not always the biggest person, or the one who yells the loudest. The primary aggressor is the one who tends to initiate the abuse and whose behavior has the greatest impact on the family system. As the family dysfunction model suggests, this could certainly be a child, but a child would rarely be considered the dominant aggressor, a legal term referring to who has the greater power and is the greater threat in an intimate partner relationship. Dad may be the primary (and dominant) aggressor if, for instance, he initiates the verbal and physical aggression towards his partner, controls the household money, and has an authoritarian parenting style. Mom may retaliate at times by hitting back, or yell at the children, and she may in fact require some help with her own issues and be a key to the family’s overall treatment success, but unless dad’s anger and violence is specifically addressed as a separate problem, the outcome is likely to be poor. In another family, if dad has thrown things, but this was in response to a constant barrage of verbal and emotional abuse from a partner who insists on making all of the family decisions, then mom would be regarded as the primary and dominant aggressor. Of course, there are times when neither party can be considered dominant, because both engage in various types of abusive and controlling behaviors – e.g., dad slams doors, has grabbed mom by the arm, controls the finances and uses the “silent treatment;” and mom initiates the verbal abuse, constantly checks on his whereabouts, and has allied herself with the children.

Research indicates that distinctions between “perpetrator” and “victim” are grossly overemphasized. In the gender-inclusive perspective, everyone is responsible for their behavior. Some individuals obviously need to be protected and given appropriate resources. Individuals who stay out of fear or due to pressing financial reasons may need special assistance in leaving their relationship (e.g., with restraining orders, refuge in a shelter). But they are nonetheless responsible for their own well-being, and to the extent that a victim remains in a relationship for personal and less pressing reasons, it would seem prudent – indeed, required – to help them evaluate their choices (Mills, 2003; Peled, Eisikovits, Enosh & Winstok, 2000) We ought to be careful not to pathologize victims (Hansen, 1995), but asking a client to address the personality characteristics that make them prone to finding abusive partners is to empower them, not blame them. Do we ignore a victim’s dependency issues because it is not “politically correct?” We cannot discount the strong likelihood that an untreated victim will at some point retaliate the abuse, either against their partner or the children; or leave the abuser only to later involve themselves in another abusive relationship, subjecting the children to further dysfunction. Children don’t care “who started it,” or how long the parent has been a victim.

We need to distinguish between true victims who unnecessarily blame themselves out of fear of the abuser, dependency needs or denial of the abuse, from situations in which a “victim” feels appropriately guilty for engaging in abuse of their own. Taking responsibility means accepting the consequences of one’s actions, regardless of victim or perpetrator status: a person whose nagging results in being physically assaulted has contributed to the cycle of violence, but this should imply neither that he/she is responsible for their partner’s behavior, nor that the partner’s behavior should be minimized. Clearly, that victim can claim the “moral high ground.” But the task of a clinician is to facilitate change, not make moral judgments. By failing to understand that systems theory is first and foremost a means of understanding and not a specific set of treatment recommendations, and by confusing “cause” and “blame,” (Felson, 2002), victim advocates have severely restricted our common efforts to combat family violence.

Treatment Options

Once the clinician has a working understanding of the family’s abuse dynamics he or she can proceed to formulate a treatment plan. Treatment may be carried out in any number of modalities, sequentially or concurrently, in whatever combinations are most promising for success. On a spectrum from most inclusive to least, those modalities are:

• Therapy with the entire family.
• Therapy with several family members – e.g., parents and one child, one parent and the children.
• Couples counseling – includes the dyad by itself, or part of a multi-couples group or anger management parenting group
• Other dyads – e.g., parent and child, two siblings
• Counseling with several family members, but individually
• Separate anger management/batterer group participation for the primary aggressor(s)
• Therapy group for the child

Safety and the Course of Treatment

It should be emphasized that “most inclusive” is not always what is best. Seeing the entire family is usually a good idea, for example, when there is a high degree of reciprocal abuse, or when the clinician needs the assistance of additional family members to confront resistance and denial. In other cases, the dysfunction is more or less contained among a segment of the family (e.g., two siblings, the parents, one parent and a child), and it would be more expeditious to narrow the treatment focus, at least initially. Of course, family therapy may be contraindicated when one or more of the preconditions outlined in table 1 have not been met. One of the most important concerns is safety. Participants cannot be expected to honestly engage in the process when they feel threatened by an untreated parent (or child or sibling). Battered women have often reported violence directed against them following a family session (Adams, 1988; Pagelow, 1981); but this is not a gender-specific phenomenon, and it matters little if that threat is physical (dad has chocked mom, requiring her hospitalization; mom has punched her daughter in the face) or emotional (mom calls her son a “little shit;” dad routinely threatens to abandon the family.)

Vetere and Cooper (2001) caution clinicians to be aware of non-verbal signs of intimidation: “If the perpetrator stops physically violent behaviour but continues to intimidate – through attitude, facial expression, physical posture and use of language – then only partial change has been achieved” (p.391). In such cases, the clinician has the choice of separating the couple or, if appropriate confronting the behavior directly, thus allowing for the possibility of insight and the corrective emotional experience for both partners that might alter a long-standing relationship dynamic.

As Goldner (1998) has articulated, safety is hardly promoted when the clinician refuses conjoint counseling against the victim’s wishes, considering that the couple will simply continue the violence outside the office, where it cannot easily be monitored. And Potter-Efron (2005) suggests that conjoint therapy may be required for even the most violent couples, as a “last resort” when everything else has been tried (e.g., several round of batterer group, separate victim services). The clinician can foster a feeling of safety in victimized family members by clearly articulating his/her position that violence is unacceptable, by offering a safety plan, and by encouraging them to call the police should they be re-assaulted. Safety will also be promoted if the course of treatment follows the author’s three-phase approach (see table 4), which emphasizes skill building and the re-establishment of trust and confidence among the family members in the first phase, and greater exploration of underlying issues and dynamics in the following phases. Appropriate treatment modalities can be found in table 5.

 

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Table 1. Preconditions for Conducting Family Therapy

• Victim and perpetrator want this type of treatment.
• The victim is aware of potential dangers, and has a safety plan.
• An adult must accept responsibility in cases of child abuse.
• There are no custody issues if the parents are going through a divorce.
• Results of a lethality evaluation indicate a low probability of danger.
• Perpetrator does not have obsessional thoughts about the victim.
• The therapists have been trained in both domestic violence and family therapy.
• None of the clients are abusing drugs or alcohol.
• Treatment is mandated in cases of substance abuse.
• Neither of the partners exhibits psychotic behavior

 

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Table 2. Gender-Inclusive Research Findings

• Both men and women can be victims and/or perpetrators.
• Victim/perpetrator distinctions are overstated, and much partner violence is mutual. Even when the violence is unilateral, overall abuse is often bilateral.
• Both genders are physically and emotionally impacted by abuse. Women suffer the greater share of physical injuries, and express overall higher levels of fear.
• Men engage in higher levels of sexual coercion and can more readily intimidate physically, but women and men overall engage in comparable levels of controlling and abusive behaviors.
• The causes of partner abuse are varied, but similar across gender, and patriarchal explanations are insufficient.
• Men and women have similar motives in perpetrating violence. “Gendered” violence may be male or female perpetrated.
• There is no automatic power imbalance favoring the man that would preclude couples or family counseling; the dominant aggressor may be male or female.
• Regardless of perpetrator gender, child witnesses to partner abuse are adversely affected, and are at risk for experiencing and perpetrating partner abuse as adults.
• There is a high correlation between perpetration of partner abuse and child abuse, for both men and women.
• Family violence is a complex phenomenon, mediated by stress, with reciprocal interactions between the individual members
• The victim of one person’s abuse maybe a perpetrator towards another in the same family, and victims who leave may become perpetrators in subsequent relationships.

 

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Table 3. Engagement and the Joining Process (Sheehan, 1997, pp. 85-86)

A. Questions that help lessen a child’s anxiety about entering treatment:

“Do you feel like you’re in the hot seat?”

“What do you think your parents want to say to me?”

“Do you think I’ll hear your side of the story, or only your parents’ side?”

B. Questions that elict a child’s “honorourable self,” capable of empathy:

“What was it like when you hit your mum? How did you feel afterwards?”

“When you’re feeling angry, do you ever notice any other feelings there as well?”

“How would you know if anyone in the family was feeling scared of you?”

C. Questions that help bring forth the child’s “agentive self,” capable of taking ction to

end the violence:

“At what point did you choose to hit your dad? Looking back, could you have chosen to act differently?

“Can you think of a time when you wanted to hit your mum, but chose not to?

What did you do instead? Was it a better idea, or not?

D. Questions that elicit the parents’ and siblings’ experiences of living with a violent child:

“What was it like for you when your daughter was being violent?”

“What will it do to your relationship if nothing changes?”

“Does your sister’s violence stop you from being her friend?”

E. Questions that encourage change by helping family members notice improvement:

“Who will notice first if Jason is making an effort to control his violence?”

“Do you think your mum and dad see you differently when you are controlling your anger?”

“Now that Kylie is making an effort, are other people in the family acting differently too?”

 

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Table 4. Phases of Treatment

[columngroup][threecol_one]

Overall approach

Psycho-educational

Goals

Eliminate physical aggression.

Avoid secondary problems.

Minimum ventilation of affect.

Built confidence and trust.

Focus on content.

Learn how anger works, conflict escalation dynamics, role of stress, impact of control and “dirty fighting” tactics, and equalitarian decision-making.

Acquire basic anger management, communication and conflict containment skills.

Type of change sought

First-order, behavioral, immediate

[/threecol_one][threecol_one]

Overall approach

Psycho-educational/cognitive

Goals

Begin to reduce verbal/psychological aggression.

Continue avoiding secondary problems, but begin addressing lesser primary problems.

More ventilation of affect.

Continue trust and confidence building.

Continued focus on content; limited discussion of process.

Identify and challenge “self-talk.”

Expand communication skills and learn conflict resolution and problem solving techniques.

Assertiveness training.

Type of change sought

First-order, behavioral, some internal

[/threecol_one][threecol_one]

Overall approach

Cognitive/insight-oriented

Goals

Eliminate verbal/psychological aggression.

Begin addressing core issues.

Full expression of affect encouraged.

Greater attention to process.

Identify belief systems underlying distorted self-talk.

Begin addressing and working through childhood-of-origin issues.

Type of change sought

Second order, systems level, internal

[/threecol_one][/columngroup]

 

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Table 5. Modalities by IPV Category

Unilateral Severe Battering: (Serious and very serious violence, extreme use of control. Highly asymmetrical power structure. Severe, multiple injuries. Perpetrator often a criminal. Little or no remorse. High level of psychopathology.) Mandatory same sex batterer group for perpetrator. Also, intensive individual psychotherapy with a clinician specializing in both domestic violence and in treating personality disorders. Supportive counseling for victim. Priority on helping him/her leave. Conjoint therapy contraindicated.

Mutual Severe Battering: (Characteristics as above, except that violence is mutual and power structure more symmetrical.) Separate same-sex batterer groups for each partner. Intensive individual psycho-therapy. Couples/family counseling after each party has acquired anger management/ conflict resolution skills.

Unilateral Common Battering/High Conflict: (Range of violence, mild to moderate injuries. Low to moderate use of control. Moderate to high asymmetry in power structure. Remorse. Less severe psychopathology.) Batterer or anger management group for perpetrator, depending on severity of violence, extent of power/control. Supportive therapy for victim. Structured couples program, or traditional couples/family counseling after cessation of violence and perpetrator shows sufficient treatment progress.

Mutual Common Battering/High Conflict: (Characteristics as above, except for greater symmetry in power structure.) More severe cases: Separate same-sex batterer groups or structured, multi-family couples group Less severe cases: Separate anger management groups, or traditional couples/family work w/clinician experienced in partner violence dynamics.

 

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Couples Therapy in Domestic Violence Cases: Phases Two and Three

A. Ongoing Tasks

• Therapist makes neutral observations on communication and behaviors, especially those exhibited in sessions.
• Avoids blaming either party, but assigns responsibility.
• Elicits the clients’ own interpretations about problems, and their own solutions, before suggesting alternatives.
• Corrects exaggerated views of an incident, e.g., a few suggestions by one’s partner can be viewed as a “harangue,” or a few negative comments in a 5 minute period become, “hours of criticism.”
• Comments on communication styles, e.g., interrupting and jumping to unwarranted conclusions. Gives couple reality checks on mistaken assumptions about the partner’s motives by asking for clarification of intent (e.g., one partner accuses the other of yelling when they merely made an emphatic statement, causing anger and defensiveness, thus reinforcing the first partner’s image of other as aggressive and dangerous.
• Points out abusive behaviors and “dirty fighting.”
• Continually reminds the couple that they are a team, and that their individual and collective efforts will be suitably rewarded. Reminds them of their goals.
• Carefully watches for episodes of regression, and sudden flights into health. The couple is reminded about the long term, incremental nature of change.
• Identifies sources of resistance: Abuse seen as normal, mutual dependence, stress of change, need to control the familiar, fear of “identity suicide,” correcting the past
• Helps the couple adjust to sudden power shifts. Typical when a victim begins to feel there is a pendulum effect, in which the victim begins expressing himself or herself aggressively, often with the same abuse as the perpetrator.

B. Attachment Work

• Identify attachment styles; explain how they lead to misunderstandings, hurt feelings and conflict escalation.
• Act as “secure base” for expression of emotion. Unlike the original parent figures, the counselor must be consistently available, showing acceptance and concern, while carefully monitoring their communication. Recommend the book, Do I Have to Give Up Me to Be Loved by You?” (Paul & Paul, 1983).
• Help couple set reasonable interpersonal boundaries, within which closeness and independence can both be pursued. Remind them that healthy relationships are like a “three legged stool” (one where the partners are strong and emotionally secure as individuals, yet work in concert to sustain a healthy, viable relationship.) Continually revisit communication skills, so the clients can better understand each other’s legitimate needs and find ways to better accommodate one other.

 

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Case Examples

CASE #1: DUAL PERPETRATOR MODEL

Joe and Evelyn Mitchell, brought their 12-year son, Drake, to a private practice marriage and family therapist, seeking help for his school problems. A middle-aged insurance salesman, Joe tried to project an outward demeanor of strength and confidence, but was overshadowed by his extremely high-strung, domineering wife, a real estate broker who did most of the talking during the first session. It was also apparent that Joe had been suffering from depression. While answering the therapists questions about his poor school attendance and failing grades, Drake revealed that he sometimes “lost it” with friends whom she perceived as disloyal. The therapist asked Drake if there was anyone else in his life who sometimes “lost it,” and he disclosed, hesitantly, that mother “screams at dad and sometimes hits him with things.” It was revealed that Evelyn also yelled at Drake, and had in fact had physically abused him for years, with hair brushes and other household objects. The week before, when he lied to her about his school attendance, she had slapped him hard enough to cause a bloody nose. And Joe had on occasion pushed and grabbed Drake, typically when under pressure from mom, once bruising his arm when he refused to clean up his room.

After the first session, the therapist asked to meet with the couple without their son. Results of the Conflict Tactics Scale and Controlling and Abusive Tactics Questionnaire confirmed that Evelyn was the dominant aggressor in the family, scoring high on the CAT dimensions of diminishment of self esteem (berating Joe for not bringing in enough income, ridiculing his sexual performance), as well as isolation and jealousy (she constantly questioned his whereabouts, accused him of having affairs.) Although severely abused, on one occasion he incurred a deep gash in his head from a fireplace poker, Joe refrained from hitting back, too scared that if he were to do so, she would leave him. Raised to not “air your dirty laundry,” he never thought of calling the police, nor sought any type of assistance from extended family or from professionals, bearing the twin burdens of family violence and his own depression in secret. His role, he told the therapist, was to be “the strong one.” Meanwhile, because of the long-standing alliance between father and son, Evelyn felt painfully alienated; and when they would dismiss her as “crazy,” and threatened to move out together, the old shame and hurt of having lived with an abusive schizophrenic mother, and having been abandoned at age seven by her father, resurfaced again. This rejection made her more angry, and justified her criticisms of Joe, causing him to withdraw, which in turn led Evelyn to lash out in desperate bids for attention.

Because of the seriousness of Evelyn’s violence and poor impulse control, the therapist referred her to a one year domestic violence/anger management group. The local battered woman’s shelter did not offer support groups for men, but a concerned worker offered to see Joe on an individual basis, providing him support and helping him understand the issue around his victimization. Claiming that the counseling was “repetitive,” he terminated after six weeks. (Later, he admitted to having felt uncomfortable in the role of “victim.”) But the family came in together for another three months, during which time Evelyn ceased her physical assaults and most of her verbal abuse, and the parents were able to work on a parenting plan to deal with Drake’s school problems. In doing so, the family hierarchy was restructured to bolster the parental subsystem. Evelyn as asked to come in for a few sessions separately with Drake, and over time (but not without some setbacks), mother was able to build a loving and healthy relationship with her son.

Encouraged with this success, the couple agreed to come in for conjoint sessions and work on their own relationship. Over the next fourteen months, the focus was first on Evelyn, and consolidating the progress she made on managing her anger; then it shifted to Joe, who found the newfound reconciliation between mother and son somewhat threatening. Joe’s own dependency needs emerged, as well as his fears of intimacy. By helping Joe learn to better assert himself and set limits on his wife’s aggression, while encouraging him to accept appropriate bids for love and attention, he gradually overcame his depression and became the genuinely strong and compassionate man he’d always wanted to be.

CASE #2: FAMILY DYSFUNCTION

Matt, a 29-year old construction worker, was referred to a batterer intervention program (BIP) at the insistence of his wife, Jackie, a stay-at-home-mom, for having shoved her. During the intake process, Matt complained to the BIP counselor that he has already done a batterer program, and that for the past two years it had been his wife who “caused all the problems.” It began, he said, with sabotaging behaviors (e.g., standing in front of the door when he attempted to take a time out), and later turned into verbal put-downs, throwing things and, finally, hitting. The BIP counselor at first assumed that Matt was in denial, like a lot of the men he worked with; until a phone consultation with Jackie revealed a more complex picture.

Meanwhile, Jackie had expressed dissatisfaction with her shelter support group, where her own problems with anger, against Matt as well as the children, seemed to be minimized. On the CTS and CTS-PC, it was revealed that Matt had punched Jackie five years before, an incident for which he was arrested, and had frequently used a belt to discipline their 13-year-old son, Andy. In the past, both parents had frequently yelled, and sometimes Jackie initiated. But the CAT also indicated that Matt often used non-verbal intimidation around Jackie – for example, cornering her in the kitchen and literally getting into her face – and he controlled the family finances, withholding his wife’s “allowance” when she gave him “a hard time.” As a result of his involvement with the batterer group, Matt eventually let go of his need for control and never hit Jackie again. Wanting more information, the therapist invited the entire family to come to the next session, and the full picture of the family’s violence and dysfunction began to emerge, one that over the years had clearly shifted from a single perpetrator to a family dysfunction model.

The pushing incident, it turned out, occurred when Matt restrained Jackie from hitting their eleven-year old daughter, Viola, after Viola had slapped her mother and called her a “bitch.” While attempting to separate wife and daughter, Matt blamed Jackie for letting the conflict escalate, and that’s when Jackie began to slap and kick her husband. When Matt pushed her away, she fell against a bookcase. Probing for antecedents, the therapist learned that earlier that day Viola had been yelling at Andy for using her Walkman without permission. Because of his age, it was Andy whom the parents typically punished whenever the siblings didn’t get along, but on this occasion the parents had decided to side with Andy after finding out that Viola had retaliated by ripping up one of his crucial homework assignments. Viola indeed had been the favored child, and for years Andy had deeply resented her. Fearing his father’s wrath, he would rarely confront her directly. Instead, he would engage in passive-aggressive behavior, such as burying her dolls in the backyard. But now, having just experienced a sudden growth spurt, emboldened by his father’s nonviolence and having internalized dad’s previously abusive coping style, Andy began to strike out physically against his sister and his mother.

Viola had previously acted as the family peacemaker when dad had been violent. She had joined mom in some counseling sessions at the shelter, and had even become a confidante. But when mom restricted her involvement with a new, more delinquent peer group in middle school, Viola turned on her. Recognizing the dangerous, escalating nature of these shifting dynamics, the therapist requested that everyone come in together for therapy. Partly during these sessions, and in the course of a separate 26-week family violence parent program for Matt and Jackie, the therapist educated them about family abuse dynamics, the intergenerational cycle of violence, and pro-social ways with which to handle conflict. Adjunct sessions with Andy and Viola were helpful in shoring up the sibling subsystem, and to reduce the enmeshment between mother and daughter. Later, conjoint sessions with the parents addressed some of the issues in their relationship, including Jackie’s lingering difficulties in trusting Matt not to be violent, as well as Matt’s plummeting self-esteem following an extended lay-off from his job. The therapist helped the couple adjust to the stress of changing gender roles when Jackie found work as a legal secretary (something that Matt initially protested). Within six months, Matt had found another job, and in the meantime, had spent valuable and needed time mending his relationships with his children.